Orient Journal of Medicine最新文献

{"title":"Cost effectiveness of Tuberculosis Treatment from the Patients' Perspective","authors":"L. Ogbonnaya","doi":"10.4314/OJM.V16I3.29078","DOIUrl":"https://doi.org/10.4314/OJM.V16I3.29078","url":null,"abstract":"Objective: I o compare the cost-effectiveness of two strategies for supervising the Directly Observed Treatment Short course (DOTS) during the intensive phase of Tuberculosis treatment. Methodology: 600 newly diagnosed previously untreated smear-positive pulmonary tuberculosis patients were randomly assigned to the study and control groups. \u0000A trained lay supervisor supervised each study group patient at home while nurses supervised the control group patients at the clinic. \u0000Results: At the end of the study, the control group incurred personal cost in transport fare 14 times higher, and lost income 6.5 times more, than the study group. \u0000Conclusion: It is concluded that home-based lay worker supervised Directly Observed Treatment Short course is more cost effective from the patients' point of view. \u0000DOTS needs to be re-focused out of the hospitals and clinics and made community based in view of the increasing TB caseload occasioned by HI V/AIDS. Key Words: Cost effectiveness, Tuberculosis treatment, personal cost, patient's perspective Orient Journal of Medicine Vol.16(3&4) 2004: 1-6","PeriodicalId":104404,"journal":{"name":"Orient Journal of Medicine","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2005-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127856760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pattern of Neonatal Admission and Outcome at a Nigerian tertiary Health Institution","authors":"S. Obi, B. Onyire","doi":"10.4314/OJM.V16I3.29083","DOIUrl":"https://doi.org/10.4314/OJM.V16I3.29083","url":null,"abstract":"Aim: To describe the pattern of neonatal admission in a tertiary health institution in a developing country and to identify factors associated with its outcome. \u0000Subjects and Methods: A retrospective review of 447 neonates admitted at Federal Medical Centre Abakaliki, Nigeria over a 3-year period (November 2000-October 2003). \u0000Results: A total of 447 newborn babies were admitted into the Newborn Special Care Unit (NBSCLJ) with the inborn and out born babies constituting 89.3% and 10.7% respectively. Neonatal sepsis (32.4%), prematurity (28.6%) and neonatal asphyxia (14.8%) were the commonest indication for admission. The overall mortality was 19.5% with majority of the deaths occurring in the first week of life. The identified risk factor for neonatal death included birth weight less than 1500g, place of birth, mode of delivery, certain maternal-related factors such as ignorance, low socioeconomic status, non-attendance to antenatal clinic and low parity. \u0000Conclusions: Improved access to antenatal care, maternal health education and upgrading existing infrastructure in tertiary institutions will significantly reduce neonatal mortality. Key Words: Neonatal admission pattern, outcome, tertiary institution, Nigeria. Orient Journal of Medicine Vol.16(3&4) 2004: 31-37","PeriodicalId":104404,"journal":{"name":"Orient Journal of Medicine","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2005-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133751645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Pharmacology Of Malaria","authors":"C. Chijioke","doi":"10.4314/OJM.V16I2.29077","DOIUrl":"https://doi.org/10.4314/OJM.V16I2.29077","url":null,"abstract":"Effective chemotherapy of malaria relies on an accurate diagnosis and an appropriate affordable choice of drugs bearing in mind likely adverse effects, patterns of drug resistance, and the degree of host immunity. \u0000Choice of Antimalarial Drug: Treatment of multidrug-resistant Plasmodium falciparum malaria prevalent in our environment relies increasingly on combination chemotherapy using blood schizonticides. Chloroquine and Sulfodoxine/Pyremethamine have been cheap and safe options. However widespread resistance to these drugs (and the problem of chloroquine-related pruritus) means that these agents are often ineffective. Quinine has been relied on for multidrug-resistant malaria. However its marked toxicity potential (e.g. cinchonism and ventricular tachyarrhythmias) means that other drugs such as mefloquine, doxycycline, chlorproguanil-dapsone and proguanil-atovaquone are preferred. Halofantrine is not recommended because of its cardiotoxic potential. Increasing problems with drug resistance have led to current recommendations for the use of artemisinin-based combination therapy such as co-artemether (artemether plus lumefantrine). Plasmodium vivax, P. ovale and P. malariae remain sensitive to chloroquine, and likewise the emergent parasite P. knowlesi . Primaquine is used to eradicate hypnozoites of P. vivax and P. ovale . \u0000Treatment of malaria: Prompt treatment is of vital importance, especially in patients who lack innate or acquired immunity. Delaying effective treatment increases morbidity and mortality. Circumstances such as pregnancy and infancy should be taken into account, for example to avoid possible teratogenic effects of mefloquine, artemisinins or halofantrine during the first trimester, and to avoid primaquine and halofantrine while breastfeeding. Supportive treatment is important in severe malaria. Fever is part of the host defence against infection and so should not be entirely suppressed. Careful attention should be paid to fluid balance, to postural hypotension and hypoglycemia (which are exacerbated by quinoline antimalarials), to accompanying bacterial infections, renal impairment and the need for anticonvulsants or blood transfusion. \u0000Therapeutic failure may be due to a wrong diagnosis, or an additional cause for the febrile illness apart from malaria. Parasite resistance to antimalarials, poor patient compliance, and the use of fake or substandard drugs are alternative explanations. Key Words: Malaria, Drug treatment of Malaria, Clinical Pharmacology Orient Journal of Medicine Vol.16(2) 2004: 59-69","PeriodicalId":104404,"journal":{"name":"Orient Journal of Medicine","volume":"152 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2004-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123318145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparative Study Of Home-Based Lay Worker Supervised And Facility-Based Health Worker Supervised Dots In Enugu, Nigeria","authors":"L. Ogbonnaya, C. Obionu","doi":"10.4314/OJM.V16I2.29070","DOIUrl":"https://doi.org/10.4314/OJM.V16I2.29070","url":null,"abstract":"Setting: The chest clinic of the University of Nigeria Teaching Hospital, Enugu Nigeria, the main referral tuberculosis treatment centre for Enugu and its environs. \u0000Objective: To compare the efficacy of home-based lay worker supervised DOTS with facility based health worker supervised DOTS during the intensive phase. \u0000Design: 600 consecutive newly diagnosed and previously untreated smear positive pulmonary tuberculosis patients were randomly assigned to either of 2 groups: study and control. A relation trained as DOTS supervisor supervised each study group patient at home while the clinic nurses supervised the control group patients at the clinic. \u0000Results: At the end of the study, 77.3% of the study group compared with 72.7% of the control group achieved sputum conversion (X 2 = 1.7422; P > 0.05). Similarly, 92% of the study group compared with 90% of the control group completed treatment (X 2 = 0.7326; P > 0.05). \u0000Conclusion: Trained lay supervisors were able to supervise DOTS at home during the intensive phase, and patients supervised by them achieved slightly better results than those supervised by clinic nurses, though the differences were not statistically significant. \u0000It is therefore recommended that home based DOTS using trained lay supervisors be incorporated into the national tuberculosis control programme in Nigeria. Key Words: Tuberculosis, Control Programme, DOTS supervision, Nigeria Orient Journal of Medicine Vol.16(2) 2004: 1-6","PeriodicalId":104404,"journal":{"name":"Orient Journal of Medicine","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2004-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116043629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Review Of Clinical Features Of Malaria","authors":"B. Onyenekwe, G. Adimora","doi":"10.4314/OJM.V16I2.29076","DOIUrl":"https://doi.org/10.4314/OJM.V16I2.29076","url":null,"abstract":"Malaria has had a major impact on the life and economies of affected populations since antiquity. Ancient Assyrian, Chinese and Indian religious and medical texts made references to intermittent and seasonal fevers. Hippocrates in 500Bc first described the clinical features of malaria and some of its complication. Association of fever with stagnant water and swamps, led to the drainage of such waters by the Greeks and Romans in the 4th, 5th and 6th century BC. In the early 17th century, the “Peruvian Bark” or Jesuits Powder” was discovered to be of value in the treatment of certain fevers. The tree was later to be named cinchona from which quinine was extracted in 1820. Such fever was known as the agues in England, in Italy as mal'aria and in France as Palludisme due to their association with the fetid air of marshlands. Malaria was an effective obstacle to the colonization of the African heartland by the European Powers in the 16-19th centuries; till quinine chemoprophylaxis was introduced in 1850. Significant progress was made in the understanding of malaria with the description by Laveran of malaria parasites in blood film in 1880. Ronald Ross in 1891 demonstrated the development of malaria parasites in mosquitoes. Patrick Mansion in a series by field experiments confirmed the transmission of malaria by the bite of Anopheles mosquitoes in 1900. \u0000The worldwide distribution of malaria peaked by the end of the 19th and beginning of the 20th country. Apart from the tropics and subtropics, it was common in the temperate lands including the USA, Europe, Northern Eurasia and Asia. In the early part of the 20th century larvicidal and natural methods were engaged to control vector breeding. The ravages of malaria during the World Wars, and the scarcity of quinine stimulated research into discovery of synthetic antimalarials. This resulted in the introduction of pamaquine in 1924 (Germany), mepecrine 1930 (Germany), chloroquine1934 (Germany), proguanil 1944 (England) amodioquine 1946, primaquine 1950 and pyrimethamine in 1952 (USA). DDT, (dichlorodiphenyl –trichloroethane ) with residual insecticidal action was discovered in Switzerland in late 1940 raising great hopes for the prospect of global malaria eradication. In 1957 the world health organization launched the Global Malaria Eradication Campaign. The programming went on for the next 15 year with excellent results in North America, Europe, Former USSR, part of Asia and Australia. The result in tropical countries was less dramatic. \u0000Malaria continues to be a major cause of human morbidity and mortality. It is the world's largest killer of all parasitic diseases and a major public health problem. Although malaria has been eradicated in most temperate zones, it still affects 40% of the world population living in endemic zones of the tropics and subtropics namely; Central and South America, Hispaniola, Sub-Saharan Africa, the Indian subcontinent, South East Asia, Middle East and Oceania [Fig. 1]. Curre","PeriodicalId":104404,"journal":{"name":"Orient Journal of Medicine","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2004-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124167360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential Effects of Domestic Energy on the Health of Women","authors":"E. Enwereji","doi":"10.4314/OJM.V16I2.29073","DOIUrl":"https://doi.org/10.4314/OJM.V16I2.29073","url":null,"abstract":"Objective: To highlight the various potential health problems women and others exposed to gases/substances emitted from domestic sources of energy are at risk of. A review of the literature on the health problems associated with use of various forms of energy fuels was done. \u0000Review: Not much literature has emanated from Nigeria on the health effects on users of domestic energy. Sources of domestic energy in Nigeria include coal; firewood; kerosene; liquefied natural gas (LNG); electricity and sawdust. The gaseous and other chemical emissions by these materials in the course of energy production have been recorded as having adverse effects on the health of the users and other exposed persons. \u0000In Nigeria, the bulk of the domestic chores during which people are exposed to the effects of these gases, are done by women. \u0000Conditions such as cooking in overcrowded areas predispose to the different health problems. With a source such as coal, users in overcrowded areas experience health problems such as asthma, chronic cough, eye irritation, headache and others. \u0000Conclusion: The health effects of exposure to emissions from domestic energy sources are felt mostly by women. Different levels of risks are associated with different energy fuels with coal the most hazardous. Most of the damage is to the respiratory system. There is a need for clinical and epidemiological data to be collected and collated to study the problem. Key Words: Energy use, Pollutants, Environmental damage Orient Journal of Medicine Vol.16(2) 2004: 20-23","PeriodicalId":104404,"journal":{"name":"Orient Journal of Medicine","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2004-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134608147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Review of Paediatric Admissions In Mongomo Provincial Hospital, Wele Nzas, Equatorial Guinea","authors":"N. Onyire","doi":"10.4314/OJM.V16I2.29071","DOIUrl":"https://doi.org/10.4314/OJM.V16I2.29071","url":null,"abstract":"Background: The author was part of the Technical Aid Corps team of the Nigerian Government to Mongomo Provincial Hospital, Wele Nzas province of Equatorial Guinea, between May 1997 and June 1999. \u0000Objective: The objective of this report is to determine the pattern and outcome of paediatric admissions at Mongomo Provincial Hospital. It is hoped that the findings will be of value to future medical volunteers to this region and also to donor agencies. \u0000Materials And Methods: Case notes of all admitted children were examined. Data collected were age, sex, diagnosis, residential area, duration of hospitalization and outcome. Approval was obtained from the hospital authority to publish the data. Results: There were a total of analyzable 1166 admissions. The major indications for admissions were malaria 330(28.3%), severe anaemia 239(20.5%), pneumonia 204(17.5%), diarrhoeal diseases 196(16.8%), protein energy malnutrition 48(4.1%), septicaemia/meningitis 42(3.6%). Eight hundred and seventy (74.6%) were discharged home, while 70(6.0%) were discharged against medical advice, 44(3.8%) absconded and 178(15.3%) died. Severe anaemia, malaria, pneumonia, diarrhoeal diseases accounted for over 70% of the deaths. \u0000Conclusion: Childhood morbidity and mortality in this province were mainly from infections and anaemia. Any effective health assistance to the children of this province must include provision of potent and affordable anti malaria drugs, efficient blood bank services, clean water supply and promotion of optimal breastfeeding practices. Key Words: Paediatric Admissions, Equatorial Guinea Orient Journal of Medicine Vol.16(2) 2004: 7-12","PeriodicalId":104404,"journal":{"name":"Orient Journal of Medicine","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2004-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126377655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Material Resources For Eye Care Delivery In Urban South-Eastern Nigeria","authors":"B. Eze, C. Chuka-okosa, U. Ezepue","doi":"10.4314/OJM.V16I2.29072","DOIUrl":"https://doi.org/10.4314/OJM.V16I2.29072","url":null,"abstract":"Objectives: To determine the availability and distribution of material resources for primary and secondary level eye care delivery in Enugu-North Local Government Area (LGA) of Enugu State. \u0000Methods: A survey of Public (State and Local Government administered) health care facilities in Enugu North LGA was done. The health map of Enugu North Local Government Area was read to identify available health care facilities. Each facility was visited. A pre-tested, observer–administered questionnaire was used to interview the administrative heads of all the health care facilities in the LGA. The population of the Local Government Area was obtained from the Enugu office of the National Population Commission (NPC). \u0000Results: The population of the area is 522,926. These persons are distributed in the three health districts as follows: Coal Camp – 157,179, Asata/Ogui – 157,577 and New Haven – 208,170. \u0000There are fourteen public primary and secondary level health care facilities in the Enugu North LGA. These are unevenly distributed in the three health districts of Coal Camp (64.29%), Asata/Ogui (28.59%) and New Haven (7.14%). Altogether primary level health care facilities made-up 13 (92.9%) of the facilities while there is only one (7.1%) secondary level health care facility in the LGA. \u0000Materials for eye care are available in only the secondary level health care facility. The materials for basic eye care in the primary level health care facilities were limited and were only found in 61.54% of such centres. Basic drugs for eye care delivery were always available in 4 (28.97%) centres; occasionally available in 4 (28.97) centres; and unavailable in 6 (42.86%) centres. \u0000Conclusion: \u0000The materials available for eye care delivery in Enugu North LGA are inadequate. The available materials are unevenly distributed. The possible reasons for the uneven distribution are, historical, political and geographic. These findings constitute barriers to uptake of eye care services Key Words: Eye care, material resources, availability and distribution of material resource. Orient Journal of Medicine Vol.16(2) 2004: 13-18","PeriodicalId":104404,"journal":{"name":"Orient Journal of Medicine","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2004-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116265524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malaria: Entomological Aspect","authors":"M. Eluwa","doi":"10.4314/OJM.V16I2.29075","DOIUrl":"https://doi.org/10.4314/OJM.V16I2.29075","url":null,"abstract":"Preamble: “Of all the ills that afflict mankind few have taken a higher toll than malaria”1. \u0000Known vectors: Of the three generae in the mosquito tribe Anophilini, only the genus Anopheles contains species of medical importance. Of the 400 species or so of Anopheles known, few members are established as sole transmitters of malaria: they are thus the most important vectors of human disease in the world. Gordon & Lavoipierre2 lists some 25 species of Anopheles as capable of feeding on man. No more than 10 species of Anopheles act as transmitters in any one continent, with one or two species only serving as the main transmitters of malaria. \u0000The West African species, A. gambiae (described as highly anthropophilic) and A. funestus (described as markedly anthropophilic) have wide distribution in the zone as well as in Africa and indeed are the major transmitters. A. melas is the West African salt water form. A. nili, A. moucheti, A. hargreavesi, A. melas and A. hancocki are vectors of malaria only in limited areas of West Africa. \u0000As of today, only 4 species of Plasmodium namely, P. falciparum, P. vivax, P. ovale and P. malariae are recognized as causing malaria in man. P. ovale is the rarest type and seems confined to West Coast of Africa, where it produces mild infection. P. falciparum and its relative P. reichenowi of Chimpanzees and gorillas constitute simian malaria. Key Words: Malaria, Malaria Vectors, Malaria Entomology Orient Journal of Medicine Vol.16(2) 2004: 31-37","PeriodicalId":104404,"journal":{"name":"Orient Journal of Medicine","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2004-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131197871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards Malaria Control In Nigeria: Review Of Multiple Aetiological Factor","authors":"C. Onwasigwe","doi":"10.4314/OJM.V16I2.29074","DOIUrl":"https://doi.org/10.4314/OJM.V16I2.29074","url":null,"abstract":"Malaria is a principal cause of morbidity and mortality in the very young children and pregnant women in sub-Saharan Africa. Although Plasmodium falciparum, the most dangerous of the four human malaria parasites, is responsible for infections in the area, other aetiological factors exert a lot of influence on occurrence and transmission of malaria. For malaria to be effectively controlled and prevented, such factors which include environmental, host, vector and parasite factors must be attacked through a multi-pronged approach, in line with the strategies of the Roll Back Malaria initiative. This review highlights the various aetiological factors of malaria, and suggests ways of combating the infection in Nigeria. Key Words: Malaria, aetiological factors, Roll Back Malaria initiative, prevention and control Orient Journal of Medicine Vol.16(2) 2004: 24-30","PeriodicalId":104404,"journal":{"name":"Orient Journal of Medicine","volume":"135 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2004-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124340313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}